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Understanding Our Release of Information (ROI) Authorization Form

  • Writer: Human Resource
    Human Resource
  • Dec 4
  • 2 min read

At New Hope Services, your privacy, dignity, and autonomy are our top priorities. To support your care effectively—and to keep your information protected—we use a Release of Information (ROI) Authorization Form. This form allows you to choose who we can share information with, what information can be shared, and why it is being shared.

The ROI form puts you in control of your personal records.



What Is an ROI Form?

A Release of Information form is a document that gives New Hope Services permission to release, obtain, or exchange specific information with another person or organization. This may include healthcare providers, case managers, family members, schools, or other agencies involved in your care.



What You Can Choose

When completing the form, you decide:

  • Who we can share information with

  • What type of information can be shared (such as service records, assessments, medical details, billing info, etc.)

  • Why the information is being shared (care coordination, referrals, legal needs, insurance, personal use, and more)

  • How information may be shared (verbal, paper, electronic)

  • How long the authorization lasts

You may also revoke your authorization at any time.



Why the ROI Is Important

This form ensures:

  • Better and more coordinated care

  • Clear communication among your support team

  • Protection of your rights and privacy

  • Compliance with state and federal confidentiality laws

We only share information with your permission, and only as specified by you.



Your Rights

You have the right to:

  • Review the form before signing

  • Limit the information shared

  • Refuse to sign (services are not dependent on signing)

  • Revoke your authorization at any time in writing


New Hope Services is committed to handling all client information responsibly, respectfully, and safely.



Need Help Completing the Form?


Our staff is always here to assist you. If you have questions or need guidance filling out your Release of Information Authorization Form, please contact our office—we’re here to support you every step of the way.



 
 
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